Patient-Centered Multidisciplinary Care Key to Value-based Care

One of many benefits of attending the 2019 Pharmacy Quality Alliance (PQA) Annual Meeting is the actionable insights gleaned from conversations and sessions regarding every corner of the industry. This year, informed discussions surrounding the development of measures to improve medication services and how pharmacists can play a larger role in the multidisciplinary care team were a focus of the event.

Below are some key takeaways and actionable items from another successful event.

The unsung role of pharmacists and the potential to expand patient benefits

A major part of delivering value-based care to customers comes from the expectation that all clinicians can perform to the top of their licensure. That means dedicating more time to the highly skilled work that they have spent years learning—caring for patients—as well as perfecting and distributing the clinical workload so that capacity is maximized in the interest of patient-centered care.

To achieve an effective time-management balance, physicians and pharmacists can share the responsibility for services such as medication access, immunizations, and therapeutic disease management. Sharing these tasks can provide tremendous value by increasing the capacity of physicians, integrating a trusted pharmacist into the patient care team, and potentially reducing wait times for patient appointments. Sharing these tasks can minimize barriers to a patient starting and staying on drug therapy.

In addition, positioning the pharmacist as an integral member of the clinical care team who can provide comprehensive medication review services can also result in patient benefits, such as faster start to therapy, improved medication synchronization, and better adherence to name a few. Not only can these benefits make life simpler for patients through follow-up appointments, they also encourage ongoing engagement with a key member of the care team, the pharmacist, which potentially results in fewer adverse events and better adverse effect management.

Integration of systems, data, and care teams can benefit patients

The University of Michigan health system implemented an innovative care delivery model that placed clinical pharmacists within primary care practices. Through collaborative practice agreements, the pharmacists’ scope of practice increased as they became part of an interdisciplinary care team and allowed them to provide services typically provided by a physician.

This model provides great value to patients and can serve as a model for others to emulate due to the positive and measurable impact on patient care and outcomes. The health system also piloted a collaboration with local retail pharmacies by allowing these pharmacies to document assessments, such as hypertension screenings and counseling sessions within the patient’s chart. This allowed the pharmacies to establish patient-centered medical homes (PCMH) for follow-up visits, making access to care easier for patients while minimizing preventable setbacks that can lead to hospitalizations or expensive testing.

By extending the provision of care from the large academic institution to the clinical pharmacists, U of M provided more advanced care management at an easily accessible, community-based location, and fostered teamwork aimed at benefitting the patient. Empowering pharmacists and maximizing the convenience factor for patients strongly encourages drug adherence and diminishes the need for costly services, such as follow-up testing or, ultimately, readmission to the hospital.

The model used at the U of M also reinforces the pivotal role data sharing plays in achieving true value-based care. The easier it is for providers to access the total patient record, the less likely are clinical errors and the more value patients will realize.

Another innovative care model that relied heavily on data and the pharmacist in the practice setting involved the implementation of quality measures to improve safe use of biologic response modifiers (BRM) at the University of Illinois Health. Due to safety concerns with BRMs, screening and monitoring criteria were established to evaluate adherence to the system-wide guidelines.

Using a pharmacist-managed Virtual Consult for Rheumatoid Arthritis patient interventions, UI showed significant improvement in pre- and post-implementation safety monitoring with BRM therapy. Incorporating a pharmacy service dedicated to implementing and measuring quality measures can improve outcomes. Open streams of communication will also encourage sharing of patient-reported performance measures, an invaluable source of first-hand feedback that helps pharmacies improve patient outcomes.

Future of quality measurement

Conversations at PQA this year focused on the need to derive quality measures from actionable patient data. As the industry moves toward value-based care, the ability to share best practices to establish what true value looks like and what defines a positive treatment outcome will be a critical aspect of quality measurement.

To get there, organizations such as PQA search for consistent ways to measure performance, promote industry best practices, and demonstrate the value of pharmacy services in an integrated care model. In turn, those directives lead to high quality, high value patient care and optimized outcomes.

Quality measurement presents yet another opportunity to elevate the role of the pharmacist in the patient care team. For instance, organizations such as PQA can identify quality measurement goals shared by pharmacists and payers to create a list of patient care objectives that will lead to the best possible outcome while keeping costs down for each stakeholder. The pharmacist’s input on objectives such as preventative services, turnaround time for prescriptions, or chronic disease management best practices will help set obtainable goals that result in true value for patients.

Overall, this year’s annual meeting provided invaluable feedback from fellow attendees and speakers for us as an industry to continue our work to establish pharmacist-provided, value-based care and provide patients with the outcomes they expect. As patient expectations continue to change, the role of pharmacists on a multidisciplinary care team will need to change as well. But through innovative care models that prioritize the patient and using mechanisms that deliver on quality—such as elevating the role of the pharmacist—we can deliver on those expectations.